23 July 2015
Churchill Medical Centre is situated in Kingston upon Thames, Surrey, one of 27 practices within Kingston CCG. The practice had a Personal Medical Services (PMS) contract for providing general practice services to the local population. It also provides some enhanced services such as extended hours and remote care monitoring.
Churchill Medical Practice is registered with the Care Quality Commission to carry on the regulated activities of Family planning; Diagnostic and screening procedures; Surgical procedures; Maternity and midwifery services and Treatment of disease, disorder or injury. The surgery opening hours are Monday to Friday 8:00am - 8:00pm and Saturday 8:30am - 11:10am (the telephone lines closed at 10:00am on Saturdays and at 6.30pm during the week).
The practice had a patient list of approximately 17000 at the time of our inspection. The staff team at the practice were nine male GPs, eight female GPs, five female practice nurses, three female healthcare assistants and a practice administrative team including a practice manager, an operations manager, manager for IT, reception and the office, and over 20 reception and administrative staff.
The practice had above the England average of patients aged up to four; for patients aged between 25-29, 30-34, 35-39 and 40-44 but below the England average for all age groups above 50 and those aged between 10 and 19.
The practice has a lower percentage (than the national average) of people with a long standing health condition (35.5% compared to 54.0%); and a lower percentage (than the national average) of people with health related problems in daily life (37.1% compared to 48.8%). The average male and female life expectancy for the practice was slightly above that of the national average.
The main BME groups in the borough are Indian/British Indian (4%), Sri Lankan (2.5%), African (2.3%) and Korean (2.2%). The Korean population in New Malden is estimated to be the largest in Europe. The Indices of Deprivation rank Kingston upon Thames as the third least deprived local authority in London. The practice has a deprivation score of 13.8, compared to the national average of 23.6, however the rate of homelessness applications accepted in Kingston for 2013-14 was 3.04 households per 1,000 (which was higher than the England average of 2.32).
Churchill Medical Centre has two additional branch practices situated in Surbiton and Ham, Surrey. They were visited as part of this inspection. The practice has opted out of providing out-of-hours services to its own patients, directing them to the NHS 111 service.
We noted that the practice maintained a record of significant events however it had not notified the Care Quality Commission, where appropriate, of these, in accordance with the Care Quality Commission (Registration) Regulations 2009. This was brought to the attention of the provider.
23 July 2015
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Churchill Medical Centre on 2 June 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services to the six population groups we inspect - People whose circumstances may make them vulnerable, Older people; People with long-term conditions; Families, children and young people; Working age people (including those recently retired and students); and People experiencing poor mental health (including dementia).
Our key findings across all the areas we inspected were as follows:
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
- Risks to patients were assessed and well managed.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance.
- Staff had received training appropriate to their roles and any further training needs had been identified and planned.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff felt supported by management.
- Staff were aware of the practice’s vision and values and contributed towards them. The practice had achieved an Investors in People award.
- The practice proactively sought feedback from staff and patients, which it acted on. This included creating a specific children’s waiting area.
- The practice has a schedule of audits, which included re-auditing.
- Patients appreciated the flexibility of being able to access services at any one of three sites.
- Parentcraft classes were provided and the cost covered by the practice.
- The practice had some satisfactory Quality Outcome Framework (QOF) outcomes but was below the national average in a number of areas including diabetes and dementia.
- Patient satisfaction with the appointment system and the availability of their preferred GP fell below the Commissioning Contracting Group (CCG) and national averages.
- We found some out of date oxygen masks, although the practice did also have masks that were within their expiry date.
We saw several areas of outstanding practice including:
- The practice had won a NICE (National Institute for Health and Care Excellence) shared learning award in 2014 for its antibiotic prescribing programme which was adopted by the CCG.
- The health care assistants ran a ‘Weigh to go’ exercise and healthy eating class in the evenings and leaflets advertising this were on display in the waiting room.
However there were areas of practice where the provider needs to make improvements. Importantly the provider should:
- Ensure all equipment, including oxygen masks are within their use by date.
- Provide health care assistants with identified clinical supervision.
- Ensure all clinical staff have up to date hepatitis B vaccination.
- Ensure established protocols regarding immunisations are in place, particularly regarding patient specific directions.
- Introduce a cleaning checklist so staff know what has been cleaned and when.
- Ensure that fire emergency action plans are regularly rehearsed, and the fire risk assessment periodically reviewed.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
23 July 2015
The practice is rated as good for the care of people with long-term conditions (LTC). The practice had a below average number of patients with a long-standing health condition, with 35.5% compared to 54.0% nationally. There were 3,256 patients in this category registered with the practice, representing 18.8% of the total practice population.
Nursing staff had lead roles in LTC care including providing a diabetic clinic (up to tier 3), asthma, chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) management. The health care assistants had been trained in a number of areas to assist with LTC management, including smoking cessation and weight management.
All these patients had a named GP and a structured annual review to check that their health. Longer appointments and home visits were available when needed. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
We saw that over 90% of patients with COPD, CHD and diabetes had had a review in the past year however QOF outcomes for patients with diabetes were below the national average, whilst the percentage of patients aged over 6 months to under 65 years in the defined influenza clinical risk groups that received the seasonal influenza vaccination was 45.66% compared to 52.29% nationally.
23 July 2015
The practice is rated as good for the care of families, children and young people. There were 4,201 patients in this category registered with the practice, representing 24.3% of the total practice population. The practice had above the national average for the number of children registered who were aged under four years. Appointments were available outside of school hours and the premises were suitable for children and babies. In 2014, in response to requests from parents, the practice created a children’s waiting area.
The level of childhood immunisations were in most instances comparable to the CCG average. Exceptions to this were Meningitis C at 12 months (67.7% compared to the CCG average of 74.8%) and PCV booster at 5 years (79.3% compared to the CCG average of 87.4%).
We saw good examples of joint working with midwives and health visitors. A health visiting team was based at the practice and offered a drop in baby clinic as well as providing ante and post natal services. A midwife from the local hospital visited the practice bi-weekly to provide ante-natal care.
The practice offered all patients access to parent-craft classes free of charge. These included early pregnancy classes and breastfeeding support. The practice offers a walk-in family planning clinic for registered and unregistered patients, and one of the nurses was also able to offer coil and implant fitting.
23 July 2015
The practice is rated as good for the care of older people. There were 676 patients in this category registered with the practice, representing 3.9% of the practice population. All of these patients had a named GP. The practice had below the CCG average for the number of patients in all age groups above 65 years.
The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. In conjunction with a national charity the practice had developed and piloted an award winning Stay Well at Home programme, which targeted the vulnerable elderly for extra support to enable them to remain independent in their home.
The practice nurses undertook routine reviews of all our housebound patients. For housebound patients experiencing an acute problem requiring immediate attention, the practice made use of the rapid response team who saw patients within 2 hours (the rapid response team is a pilot initiative between London Ambulance Service and Kingston CCG. It was created to offer an alternative service to an ambulance dispatch and can see and treat people in their own homes).
Data showed that the practice performed in line with the CCG average for most conditions commonly found in older people, however it fell below the CCG average for the percentage of patients aged 65 and older who have received a seasonal flu vaccination, achieving 62.35% compared to 73.24%. Post the inspection the practice commented that this had now risen to 69%.
23 July 2015
The practice is rated as good for the care of working-age people (including those recently retired and students). There were 12,584 patients in this category registered with the practice, representing 72.9% of the total practice population, which was above the national average. The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
The practice was proactive in offering online services, such as repeat prescriptions, as well as a full range of health promotion and screening that reflected the needs for this age group, for example by offering a meningitis C vaccination programme for college students. There were extended opening hours from 8.00am to 8.00pm weekdays as well as Saturday mornings. The practice also offered telephone consultations for those unable to get into the surgery
23 July 2015
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 616 patients in this category registered with the practice, representing 3.6% of the total practice population.
The practice exceeded the England and CCG averages for having a comprehensive care plan in place for patients with schizophrenia, bipolar affective disorder and other psychoses achieving 91% compared to the England average of 86% and the CCG average of 97.7%. However it fell below the national average for the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months – achieving 60.27% compared to 88.65% (and the CCG average of 91.4%). It also fell below the national average for patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months, achieving 71% compared to the national average of 84%. The practice had taken steps to address this. For example it had rewritten its dementia protocol and had increased the number of cognitive assessments being carried out.
One of the GPs was completing a diploma in mental health run by the CCG.
23 July 2015
The practice is rated as good for the care of people whose circumstances may make them vulnerable. There were 2,827 patients in this category registered with the practice, representing 16.4% of the total practice population. The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.
The practice worked with multi-disciplinary teams in the case management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
The practice worked with a local interpreting service to facilitate appointments for patients who did not have English as a first language.
Nurses arranged routine visits to patients who were housebound and and/or very old.
A domestic violence worker was available at the practice once a week if any patient wished to speak with them.